By Emmanuela Siy
Cameroon is on track to achieve the global 95-95-95 target, that is: 95% of people with HIV know their status, 95% of those who know their status are on treatment, and 95% of those on antiretroviral have a suppressed viral load. According to USAID, Cameroon has made progress in reducing new infections with an estimated percentage of 2.7% compared to 4.3% 10 years ago. The country has a target to end HIV/AIDS as a public health threat by 2030.
The antiretroviral treatment has been free and accessible since 2007 in Cameroon. The government has also partnered with non-governmental organizations to address the issue of stigma and has created HIV/AIDS support programs to provide psychological support for HIV patients.
However, Dr. Fokam Joseph, permanent secretary of the National Committee for the Fight Against AIDS (NACC) says that “stigmatization and discrimination is hindering Cameroon’s ability to reach the 2030 target”. He added that, “there is need to fight the upsurge of new infections which are increasing amongst key populations like those from crisis hit areas, children and adolescents, in Cameroon”.
In 2022, research by Egbe Thomas, a permanent researcher in the field of public health stated that thirty-nine percent of persons living with HIV in Kumba, a crisis-hit division of the Southwest region, experienced self-stigma which leaves them feeling ashamed because of their HIV status, with low esteem and a sense of blame for contracting the disease.
Facing stigma
In a survey carried out in 2023 for the people living with HIV Stigma Index 2.0 in the ten regions of Cameroon, nearly fifteen percent of people living with HIV/AIDS chose not to access health care services because of their HIV status.
Mary is one such person. She is 47 years old and is HIV positive. Sitting on a worn-out couch in her makeshift house in the outskirt of Limbe, the wavy iron sheets which make up the walls of her home are a reminder of the hardship she is facing to take care of her three children.
“I was diagnosed with HIV in 2002. At first, I was devastated. But what followed was even worse. My husband abandoned me with these kids, and I was left alone to face the disease. I pulled off my clothes and sat, waiting for death to take me.” Her eyes cast downwards as she stares blankly at the dusty floor. “Because of all this, I really can’t go out freely”.
Mary’s husband left her ten years ago after discovering her HIV status. Her once thriving life has been reduced to a daily struggle for what to eat at home with her children. Unemployed and without steady income, she relies on the kindness of neighbors and the occasional odd jobs to make ends meet.
The stigma surrounding HIV/AIDS is a pervasive and complex issue, with far-reaching consequences for those affected which can lead to social isolation, emotional distress, and even physical harm. It represents a major obstacle to equitable access to health services, education, employment, and other fundamental rights for people living with HIV.
Moleke Iya-be works for a community outreach programme in Cameroon’s Southwest region. She has been working with people living with HIV for over twenty years and says stigmatization and discrimination against people in her community is a cause for concern in Cameroon, especially with the influx of internally displaced persons from crisis hit villages.
“Stigma has increased in this rural community recently, especially against those affected by the armed conflict in the neighboring villages of the southwest region. She recounted the story of Anita, one of their patients.
“Seventeen-year-old Anita is the oldest in a family of seven. She is HIV positive and her family separated her from the rest of her siblings. She eats alone and is given a room away from the others. She was traumatized and grew pale in the process. She even stopped taking her medication and wanted to kill herself. Right now, she is going through counseling to overcome this trauma.”
“People living with HIV are afraid to seek medical care because of the stigma,” says Dr. Njimi Fru Ningo, a medical doctor at the Muyuka Health District Hospital, a rural area in Fako division of the Southwest region. “This happens frequently given the narrative people in this community have towards HIV/AIDS. This leads to delayed diagnosis and treatment, which has a serious impact on their health.”
The doctor added that Muyuka is a small town and is still very community-based. The rural community depends on cassava biproducts to survive and they are all in touch with each other. They have an average educational background and this makes it difficult for someone to come to the hospital and collect their drugs without anyone else knowing.
“Those living with HIV in this town are afraid to come for their medicine because they are scared someone, they know may recognize them,” Dr. Njimi added.
Unfortunately, reports find that the stigma surrounding HIV/AIDS is often perpetuated by societal and cultural norms, including religious beliefs. Pascal, a seventeen-year-old resident of Yaoundé, has been HIV positive for over three years.
“I have missed so many of my appointments,” says Pascal, who declined to give his full name. “During one of them, the doctor told me to give my life to Christ so that I can be free of AIDS. I felt unholy and stopped going there.”
This doesn’t only reflect a lack of understanding about the medical realities of HIV but also perpetuates the notion that HIV is a moral failing or a punishment from God. Such attitudes, according to Lauretta Barbara, manager of the community initiative AIDS Care and Prevention, leads to further stigmatization.
“This kind of behavior is what the Cameroon Batist Convention Health services condemns. It makes it more challenging for people living with HIV to access medical care, social support and other essential services,” she noted. “That is why during our programmes those living with HIV/AIDS come together in groups, which helps them cope with the idea that they are not alone.”
Overcoming Stigma
To overcome stigma, experts say a comprehensive approach is needed, one that involves education, awareness raising, and community engagement. Ayok Nyenti is a community health assistant in the Buea municipality. He assists those stigmatized in Buea and Tiko by collecting and delivering their medication as well as provide counseling to them.
“We need to change the way we think about HIV/AIDS,” says Ayok Nyenty. “We need to understand that it is a disease and not a moral failing. We need to support those living with it rather than stigmatizing them.”
As Cameroon continues to fight against HIV/AIDS, it is clear that addressing stigma is a critical part of this effort.
“We can’t just focus on treating the disease,” says Dr. Pyllis Tchatchoua, a medical doctor at the Limbe regional hospital of the Southwest region, an urban community in Fako. “We need to address the social and emotional challenges that come with it.”
Dr. Njang Emmanuel is a district Head at the Muyuka district hospital. Every day he travels 24km (equivalent to 15 miles) through the winding and sometimes unsafe roads to Muyuka. Then he spends the rest of the day consulting, prescribing and performing procedures on the patients in this small community health district.
“AIDS-related stigma is a big public health problem,” he says, “because it makes the follow-up of patients difficult to manage, and patients might not show up for treatment.” “Sometimes, we go as far as looking for them in their homes, but they run away. They prefer private consultations and their medications given privately”.
HIV Prevalence in Cameroon
Dr. Mfochive Njindam Iliassou, is a renowned researcher and an expert in the field of HIV/AIDS and public health. His work focuses on improving healthcare for vulnerable populations like children, adolescents and those living with HIV. A survey carried out by a team of consultants working with Care Cameroon noted that stigma remains one of the main barriers preventing persons living with HIV/AIDS from accessing healthcare.
“HIV-related stigma leads to poor mental health and low adherence to antiretroviral (ARV) drugs,” he says. “Stigma is more pronounced among health workers, although there is self-stigma on the part of people living with HIV”.
In Sub-Saharan Africa, there are still twenty-five million people living with HIV/AIDS.HIV stigma remains a significant challenge in the different communities in Cameroon, exacerbating the suffering of those living with the disease.